Pediatric
Dentistry

Injuries to children’s teeth can be very distressing for children as well as their parents. Dental trauma may occur as a result of a sports mishap, an altercation, a fall inside of the home, or other causes. Prompt treatment is essential for the long-term health of an injured tooth. 

Intrusion

Allow the intruded tooth to spontaneously erupt unless radiographs indicate intrusion into the developing tooth.  The author’s experience has been to measure the amount of tooth exposed beyond the gingival margin.  The tooth is measured four weeks later.  If any re-eruption has occurred another measurement is taken four weeks later.  This is repeated until the tooth is fully re-erupted (is even with the contralateral tooth).  If the tooth exhibits no evidence of re-eruption after a four week period, extraction of the tooth is recommended to avoid ankylosis and possible injury to the developing permanent tooth.

Extrusion

Treatment depends on the degree of displacement, occlusal interferences and time to exfoliation.  If the injury is not severe ( less than 3mm extrusion) the tooth may be repositioned or allowed to spontaneously align.  When the injury is severe, the tooth is nearing exfoliation or the patient is uncooperative extraction should be considered.

Avulsion

Avulsed primary teeth are not replanted because of the potential for subsequent damage to the developing permanent tooth and the increased frequency of pulpal necrosis.  This treatment approach will be disconcerting to some parents who will urge the dentist to replant the tooth so as not to compromise the child's appearance.  The dentist should emphasize the advantage of sacrificing the primary teeth so as not to compromise the development of the permanent teeth.  Parents are advised of primary teeth replacement alternatives.